Abstract:
Background: Increased burden of multidrug resistant Enterobacteriaceae (MDRE)causing
urinary tract infection (UTI)compounded by harboring carbapenemase producing strainsbecomes
a serious threat to public health.Carbapenemase producing Enterobacteriaceae (CPE)expresses
enzymes thatcan break down carbapenems. Prevalence of MDRE in different part of the world is
increasing, but data about the incidence of CPE in is not yet documentedin Ethiopia.
Objective: The aim of the study was to assess the prevalence and risk factors of MDR and CPE
among patients with UTIs.
Methods:A cross sectional study was conducted among 442 symptomatic UTI suspected
patients atthe University of GondarHospital from February to May 2014. Systematicrandom
sampling techniquewas used to select the participants. Data onsocio-demographiccharacteristics,
clinical informationand possible risk factors werecollected using structured questionnaire. Midstream
urine samples were collected and processed to characterize bacterial isolates. Disk
diffusion method was used to determine the antibiotic susceptibility patterns of isolates. In this
particular study, CPE isolates were detected usingCHROMagar KPC medium.Data were entered
and analyzed using SPSS version 20. P-value <0.05 were considered as statistical significant.
Results: A total of 442 patients with mean age of 37.1 years were included in this study and the
majorities were females (63.8%). From 183 (41.4 %) of patients, 183 Enterobacteriaceae
isolates were identified; of which,160 (87.4%) were MDRE;the principalisolates were
E.coliandK. pneumoniae.Moreover, 5 (2.73%) of isolates were found to be carbapenemase
producers, namely E.coli (2), K. pneumoniae (2), and E. aerogenes (1). Significant drug
resistances were observed among CPE compared to other MDRE, low resistance rates were
noted to ciprofloxacin (20%). Being female (OR 4.46; P = 0.018), age (OR 1.08; P = 0.001),
hospitalization(OR 5.23; P = 0.006), and prior antibiotic use (OR 3.98; P = 0.04) were associated
risk factors with MDRE.
Conclusion and recommendations:Increased prevalence of MDRE and incidence of CPE were
indicated in this study. Attributingrisk factors for MDRE were found to be sex (female), age,
hospitalization, and history of antibiotic therapy. Therefore, efforts should be directed to
reducepatient hospital stay and to maximize rationaluse of drugs. Additional and vigorous
investigation especially on CPE should be encouraged.
